“If after a legitimate study, they find that football is the sole cause of dementia or any debilitating cognitive or neurological diseases, shut it down. Let’s quit playing.”

The Naples High School coach and member of the Florida High School Athletic Association Hall of Fame has wrestled with the issue of injuries in the sport since his days as a high school player in Arizona and a collegian at Liberty University.

He doesn’t gloss over it. It’s a violent game, more like boxing or wrestling than basketball or baseball. “You demoralize your opponent by giving him a physical pounding. That is so barbaric, so absurd to some pretty sophisticated people with great influence.”

But he remains unconvinced that a study published last week in the Journal of the American Medical Association is definitive proof that playing football causes chronic traumatic encephalopathy, a serious brain injury. The study, which showed the brains of 110 of 111 former NFL players donated to science showed damage, received blanket coverage in both sports media and mainstream news.

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Bill Kramer, head coach for the Naples High School varsity football team, talks with players at a recent practice at Staver Field.(Photo: Sarah Holm/Naples Daily News)

He realizes that because of his profession, his response to the article may be dismissed.

“If I question any of the people who are up in arms over this, then I’m a really, really bad person. It’s a very precarious position for any football coach,” Kramer said.

But Kramer doesn’t enter the fray unarmed.

Another study, also published in the JAMA just weeks before the July 25 report, showed no link between players who had played high school football in the 1950s and brain injury, cognitive ability or depression.

“Among men graduating from high school in Wisconsin in 1957, we did not find evidence that playing football had a negative long-term association with cognitive functioning and mental health at 65 and 72 years of age,” the authors, mostly associated with the University of Pennsylvania, wrote.

It received little to no coverage when it came out July 3.

Why? Kramer can’t help but wonder.

“Could it be because it rebuts a lot of the mainstream media and a lot of really passionate discourse?”

CLOSE

Research on the brains of 202 former football players has confirmed what many feared in life _ evidence of the devastating disease CTE in nearly all the samples, from athletes in the NFL, college and even high school. (July 25)
AP

Both studies have their limitations. The one published July 25 by researchers with Boston University relied on brains donated by former players or their survivors. That can lead to something called “selection bias,” said Sameer Deshpande, a co-author of the Penn study.

“You always need to worry about selection bias with non-random convenience samples. For instance, it may be the case that many of the subjects who donated their brains for study did so precisely because they were symptomatic (e.g. had been experiencing behavioral problems prior to death),” Deshpande wrote in response to an email asking about the studies.

As for the Penn study, Deshpande and the other researchers acknowledge that it looked only at football players and nonplayers who were in high school in Wisconsin in the 1950s. The sport may be different today, they say.

Also, it only studied those that had played through high school and didn’t look at those who played into college or the pros.

Kramer scoffs at the idea football is more dangerous today than in the past. Today’s athletes may be bigger and faster, but you can’t convince him they’re tougher than the players from the post-war era. “They survived World War II. They weren’t afraid of anything,” he said. Equipment today is better. Coaches teach techniques to avoid head injuries, rather than to inflict them, as was done in the past.

“Rules changes make it way safer. Even when I played, you led with your helmet. It’s how you blocked, how you tackled. You clotheslined guys. There was the head slap.”

Injuries happen in football, but they happen in other sports too. Cycling, skiing, horseback riding and skateboarding are just a few where head injuries can occur. Is football any more dangerous than those, he asks.

“I’ve struggled with the injuries my whole career, as a player, as a coach. I’ve got to put that in some context,” he said.

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Dr. Jesse Mez, one of the doctors involved in Boston University's CTE study, explains what the goal was behind the CTE Center's research.
Time_Sports

A definitive study like Kramer is calling for would be difficult, Deshpande said, but not impossible. It would entail following a large cadre of players and nonplayers through life then assessing their health years later, all the while cognizant that the game has likely been evolving. Or collecting a much larger sample of donated brains of players and nonplayers and comparing the incidence of injuries in the two groups, always wary of selection bias because getting a random sample of brains would be unlikely.

“This is the million-dollar question, isn't it? I think both approaches are good and should be pursued,” he wrote.

Deshpande cautions against reading too much into the Penn study he helped write. “Some high school coaches are saying this is vindication. That’s decidedly not what it is.”

He said he doesn’t know why the July 25 study is so widely touted while his group’s was largely ignored but added: “The issue is quite polarizing. People read what they want to read.”

He and his fellow researchers are gathering more data, hoping to study players and nonplayers from the 1970s and 1990s.

As real as the injury risk may be, Kramer said, there are positives that come from high school football. Teamwork, commitment, hard work and delayed gratification are all taught through the sport, he pointed out. “There is nothing better for a young man to do than play high school football,” he said.

That’s especially true for a reckless breed of young man, himself included, who might find trouble otherwise.

“When I was a kid, we would jump off roofs for fun. We would fistfight for fun. People may think that’s Neanderthal. But we can take guys who are attracted to that kind of risky behavior and instead of being outside the margins, we can get them inside the margins and teach them great habits that will last their lifetime. We can be great husbands, great fathers, employees, citizens."

Kramer has weighed the pros and cons of the sport many times in his mind.

In the end, he said, “I don’t have a problem coaching football.”

Connect with Brent Batten at brent.batten@naplesnews.com, on Twitter @NDN_BrentBatten and at facebook.com/ndnbrentbatten.